Pediatric chronic cough and GERD: CHEST issues expert panel report, guideline


  • International Clinical Digest
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Takeaway

  • Children with chronic cough should not undergo treatment for gastroesophageal reflux disease (GERD) in the absence of clinical features.
  • To investigate and treat for GERD, clinicians should refer to pediatric GERD guidelines.

Why this matters

  • Chronic cough burdens caregivers and providers and erodes QoL.
  • GERD is linked to chronic cough in adults, but whether it or gastroesophageal reflux causes chronic cough in children is unclear.

Description

  • CHEST Guideline and Expert Panel Report based on systematic reviews (SRs) and randomized controlled trials (RCTs).

Key details

  • Few prospective data exist.
  • For children aged ≤14 years with cough lasting >4 weeks and no underlying lung disease:
    • Without GERD symptoms such as regurgitation or heartburn, GERD treatment should not be offered to children to treat chronic cough (grade 1B, based on 4 SRs).
    • Treat those with symptoms consistent with reflux by pediatric GERD guidelines (grade 1B, based on 1 RCT and 1 SR); treat 4-8 weeks, reevaluate (ungraded, consensus-based).
    • Children should not receive acid-suppressive medications solely to treat cough (grade 1C).
    • Test according to pediatric GERD guidelines (ungraded, consensus-based).
    • Endoscopy should generally precede pH monitoring.
  • Proton pump inhibitors are associated with serious adverse events, such as lower respiratory tract infection.